<%@ include file="/view/template/header.jsp"%>
<div id="content">
	<%@ include file="/view/supply_chain/pharmacy_all.jsp"%>
	<div class="right-content">
		<div class="box">
			<div class="sub_box">
				<h1>
					<s:text name="menu.supply_chain.request_drugs"></s:text>
				</h1>
				<s:form action="request_drugs_form">
					<div class="con-part">
						<span><s:text name="requestDrugs1.requestId" />
						<img name="required" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /> </span>
						<s:textfield name="requestDrugs.requestId" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.requestId'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.drugId" /> </span>
						<s:select key="requestDrugs.drugId" cssClass="select_box"
							list="#{'1': 'Paracetamol', '2': 'Amoxicilline', '3': 'Vitamin B', '4': 'Penicillamine', '5': 'Aspirin', '6': 'Folic Acid', '7': 'Vitamin E', '8': 'Digoxin', '9': 'Benicar HCT', '10': 'Potassium Chloride'}"
							headerKey="1" headerValue="----Select Drug----"
							cssErrorClass="error" />
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.drugId'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.unitOrWard" /> </span>
						<s:select key="requestDrugs.unitOrWard" cssClass="select_box"
							list="#{'1': '1', '2': '2', '3': '3', '4': '4', '5': '5', '6': '6', '7': '7', '8': '8', '9': '9', '10': '10'}"
							headerKey="1" headerValue="----Select Ward----"
							cssErrorClass="error" />
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.unitOrWard'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.minAmount" />
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /> </span>
						<s:textfield name="requestDrugs.minAmount" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.minAmount'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.maxAmount" /> 
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /></span>
						<s:textfield name="requestDrugs.maxAmount" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.maxAmount'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.amountUnits" /> </span>
						<s:select key="requestDrugs.amountUnits" cssClass="select_box"
							list="#{'mg': 'Mili-grams', 'ml': 'Mili-litre'}" headerKey="mg"
							headerValue="----Select Unit----" cssErrorClass="error" />
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.amountUnits'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.quantity" /> 
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /></span>
						<s:textfield name="requestDrugs.quantity" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.quantity'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.urgency" /> </span>
						<s:select key="requestDrugs.urgency" cssClass="select_box"
							list="#{'High':'high','Moderate':'moderate','Low':'low'}"
							headerKey="Low" headerValue="--Select Urgency---"
							cssErrorClass="error" />
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.urgency'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.requestDate" />
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /> </span>
						<s:textfield name="requestDrugs.requestDate" id="datetimepicker"
							class="input-text" cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.requestDate'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.enteredByID" /> 
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /></span>
						<s:textfield name="requestDrugs.enteredByID" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.enteredByID'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span><s:text name="requestDrugs1.verifiedByID" /> 
						<img name="logo" src="<% out.print(baseURL);%>/view/required.jpg" width="15" height="20" alt="required" /></span>
						<s:textfield name="requestDrugs.verifiedByID" required="true"
							cssErrorClass="error"></s:textfield>
						<s:fielderror cssStyle="errorMessage">
							<s:param value="%{'requestDrugs.verifiedByID'}" />
						</s:fielderror>
					</div>

					<div class="con-part">
						<span>&nbsp;</span>
						<!-- requestDrugs.requestDrugsForm -->
						<s:submit key="requestDrugs.request" cssClass="green"
							align="center" />
						<%-- <s:submit key="requestDrugs.cancel" cssClass="green"
							align="center" /> --%>
					</div>

					<div class="con-part">
						<s:if test="%{message.message!=empty}">
							<s:property value="message.message" />
						</s:if>
					</div>
				</s:form>
			</div>
		</div>
	</div>
</div>
<script type="text/javascript"
	src="<%out.print(baseURL);%>/view/template/js/jquery-ui-timepicker-addon.js"></script>
<script>
	$(function() {
		$('#datetimepicker').datetimepicker();
	});
</script>
<%@ include file="/view/template/footer.jsp"%>
